Prevention of early infective complications after laparoscopic splenectomy with the Garamycin sponge

Marcin Migaczewski; Anna Zub-Pokrowiecka; Piotr Budzyński; Maciej Matłok; Andrzej Budzyński

doi:10.5114/wiitm.2011.27151

eISSN: 2299-0054
ISSN: 1895-4588

Videosurgery and Other Miniinvasive Techniques

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2/2012
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Original paper

Prevention of early infective complications after laparoscopic splenectomy with the Garamycin sponge

Marcin Migaczewski

,

Anna Zub-Pokrowiecka

,

Piotr Budzyński

,

Maciej Matłok

,

Andrzej Budzyński

Videosurgery and Other Miniinvasive Techniques 2012; 7 (2): 105-110

DOI: https://doi.org/10.5114/wiitm.2011.27151

Online publish date: 2012/03/27

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Introduction: Surgical site infection (SSI) appear to be more frequent in splenectomized patients than might be expected and its incidence can be explained neither by the extent of surgery nor by the risk of bacterial contamination of the operating field.

Aim: Evaluation the local antibiotic prophylaxis using a gentamicin surgical implant in order to reduce SSI, particularly subphrenic abscesses.

Material and methods: We conducted a prospective, randomized study of two groups of patients undergoing laparoscopic splenectomy who were considered at high risk of infective complications: patients with idiopathic thrombocytopenic purpura (ITP) pre-treated chronically with systemic steroids and patients with non-Hodgkin lymphoma (NHL). Out of 98 laparoscopic splenectomies performed during the study period, 40 patients with ITP and 20 with NHL met the inclusion criteria and were enrolled in the study. In 20 randomly selected patients with ITP and 10 with NHL, a gentamicin-collagen implant was left in the splenic bed.

Results: Infective complications occurred in 4 (6.67%) among 60 patients from the entire study group; 2 in patients with ITP and a gentamicin implant who developed fever of unknown cause which resolved after systemic antibiotics, and 2 in patients with NHL and gentamicin prophylaxis who developed a subphrenic abscess. In all patients operated on without a gentamicin implant, the postoperative course was uncomplicated.

Conclusions: Gentamicin surgical implants not only fail to reduce the risk of subphrenic abscesses in splenectomized patients, but may contribute to the increase in its incidence, which puts into question the possible benefits of this form of prophylaxis.

keywords:

Prevention of early infective complications after laparoscopic splenectomy with the Garamycin sponge

Marcin Migaczewski , Anna Zub-Pokrowiecka , Piotr Budzyński , Maciej Matłok , Andrzej Budzyński

laparoscopic splenectomy, infective complications, gentamicin implant

Marcin Migaczewski

,

Anna Zub-Pokrowiecka

,

Piotr Budzyński

,

Maciej Matłok

,

Andrzej Budzyński